Marty Phillip Dack, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704222015 Issued in MI

Practice address

1703 E Michigan Ave
Lansing, MI 48912-2841

Phone

(517) 913-3860

Fax

(517) 484-6864

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Edward W Sparrow Hospital AssociationGroup PAC ID 6709799166, shared by 20 NPIs, 698 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Edward W Sparrow Hospital Hospital, Lansing, MI, CCN 230230
• University of Michigan Health - Sparrow Eaton Hospital, Charlotte, MI, CCN 231327
• Sparrow Ionia Hospital Hospital, Ionia, MI, CCN 231331
• Eaton Rapids Medical Center Hospital, Eaton Rapids, MI, CCN 231324
• University of Michigan Health- Sparrow Clinton Hospital, Saint Johns, MI, CCN 231326

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Edward W. Sparrow Hospital Association

  dba Sparrow CRNA Services

  • Anesthesiology Physician
  • Lansing, MI
  • NPI 1366498107
  Medicare reassignment NPD
• Edward W. Sparrow Hospital Association

  dba Sparrow Regional Children's Center

  • Pediatrics Physician
  • Lansing, MI
  • NPI 1831139088
  Medicare reassignment NPD
• Recovery Physicians Network of Michigan

  • Addiction (Substance Use Disorder) Psychologist
  • Auburn Hills, MI
  • NPI 1689343683
  Medicare reassignment NPD
• Sparrow Carson Hospital

  dba University of Michigan Health-Sparrow

  • Internal Medicine Physician
  • Carson City, MI
  • NPI 1598490542
  Medicare reassignment NPD
• Sparrow Ionia Hospital

  dba University of Michigan Health-Sparrow Ionia

  • Critical Access Hospital
  • Ionia, MI
  • NPI 1700820065
  Medicare reassignment NPD
• Edward W. Sparrow Hospital Association

  dba Sparrow Urgent Care

  • Urgent Care Clinic/Center
  • East Lansing, MI
  • NPI 1477509313
  NPD
• Sparrow Carson Hospital

  dba University of Michigan Health-Sparrow

  • Cardiovascular Disease Physician
  • Carson City, MI
  • NPI 1063245694
  NPD
• Sparrow Carson Hospital

  dba University of Michigan Health-Sparrow

  • Rural Health Clinic/Center
  • Ithaca, MI
  • NPI 1770553547
  NPD
• Sparrow Ionia Hospital

  dba Sparrow Medical Group Ionia

  • Family Medicine Physician
  • Ionia, MI
  • NPI 1033271143
  NPD
• Sparrow Ionia Hospital

  dba Sparrow Medical Group Gastroenterology Ionia

  • Gastroenterology Physician
  • Ionia, MI
  • NPI 1487348769
  NPD
• Edward W. Sparrow Hospital Association

  dba Sparrow Cardiovascular & Thoracic Surgeons

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Lansing, MI
  • NPI 1033162326
  NPD (past)
• Mid-Michigan Physicians, PC

  • Family Medicine Physician
  • Lansing, MI
  • NPI 1841234457

  Nurse Practitioner

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Eaton Rapids Medical Center

  • Critical Access Hospital
  • Eaton Rapids, MI
  • NPI 1417044660
  Care Compare affiliation
• Eaton Rapids Medical Center

  • Emergency Medicine Physician
  • Eaton Rapids, MI
  • NPI 1730237165

  Hospital

  Care Compare affiliation
• Edward W Sparrow Hospital Association

  dba University of Michigan Health-Sparrow Lansing

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1073588711
  Care Compare affiliation
• Edward W Sparrow Hospital Association

  dba Thoracic Cardiovascular Institute

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1760710719
  Care Compare affiliation
• Sparrow Clinton Hospital

  dba University of Michigan Health-Sparrow Clinton

  • Critical Access Hospital
  • Saint Johns, MI
  • NPI 1093809824
  Care Compare affiliation
• Sparrow Eaton Hospital

  dba University of Michigan Health-Sparrow Charlotte Orthopedics

  • Orthopaedic Surgery Physician
  • Charlotte, MI
  • NPI 1043419427

  Hospital

  Care Compare affiliation
• Sparrow Eaton Hospital

  dba University of Michigan Health-Sparrow

  • Ambulance
  • Charlotte, MI
  • NPI 1093742249

  Hospital

  Care Compare affiliation
• Sparrow Eaton Hospital

  dba University of Michigan Health-Sparrow Eaton

  • Critical Access Hospital
  • Charlotte, MI
  • NPI 1942254529
  Care Compare affiliation
• Sparrow Ionia Hospital

  dba University of Michigan Health-Sparrow Ionia

  • Critical Access Hospital
  • Ionia, MI
  • NPI 1700820065
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282780800000",
    "number": "1871686337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 E MICHIGAN AVE",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489122841",
            "telephone_number": "517-913-3860",
            "fax_number": "517-484-6864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 E MICHIGAN AVE",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489122841",
            "telephone_number": "517-913-3860",
            "fax_number": "517-484-6864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DACK",
        "first_name": "MARTY",
        "middle_name": "PHILLIP",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2010-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704222015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN-COMMERCIAL",
            "identifier": "1057822",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP FAMILYCARE",
            "identifier": "200000006547",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4950304",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHILED",
            "identifier": "5008702500",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00367059",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH ADVANTAGE",
            "identifier": "1057822",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN-MEDICAID",
            "identifier": "1057822",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7952506",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PLUS BLUE",
            "identifier": "N55170013",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "200000006547",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walter Czop III, DO
• Francesca D'Introno
• Dale A D'Mello, M.D.
• D2 Dental of Michigan
• Nicholas Daane, D.O.
• Melissa Daenzer, DPT
• Gregory Douglas Dagner
• Basil Dahbur, DO
• Grace M Dahl, DDS
• Heather Dahl, CPRM-M

• Family Nurse Practitioner in Lansing, MI
• Providers in Lansing, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.